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Pot-related psychosis linked to early ‘dangerous’ use

At first, the voices he heard in his head were pleasant. But then, they turned malevolent. Jean Thibodeau, a 19-year-old University of Toronto student and avid pot smoker, became convinced he was possessed by the devil. He could see blood gushing down his chest and feel a deep gash in his neck. “I remember thinking, I’m going to die,” said Thibodeau in an interview.

His roommate became so concerned he took him to the emergency department of the Centre for Addiction and Mental Health (CAMH).

“They told me I was having a psychotic episode brought on by cannabis,” said Thibodeau, who requested that the Star use his grandmother’s surname as he is still recovering from the breakdown.

“I was shocked. We live in a society where there is such a culture around smoking dope that people think it is cool to be a stoner. Nobody ever talks about the pitfalls.”

Researchers have established a link between cannabis and psychosis among young people, although they cannot predict who will be triggered, or why.

Youths who are especially at risk are those with a family history of mental illness, or who have suffered sexual or physical abuse. Thibodeau, who went to private school and has a supportive, intact family, doesn’t fit any of these categories.

“When people start smoking before the age of 16, there is a higher risk of having a psychotic experience. We know that early use is dangerous,” said Dr. Romina Mizrahi, a psychiatrist and director of the Focus on Youth Psychosis Prevention Clinic at CAMH. “The brain continues to develop until the age of 25.”

The clinic has treated 55 teenagers and people in their early 20s for what Mizrahi calls “pre-psychosis” in the past two-and-a-half years. These are people who, like Thibodeau, report hearing voices in their heads, or experience paranoid delusions, and are referred by a family doctor or psychiatrist to the program.

“They are not sick yet, but they are having symptoms. They are still rational, and we can help prevent further experiences of psychosis or full-blown disorders such as schizophrenia,” Mizrahi explained. “We advise them to abstain from smoking marijuana.”

Experts do not believe that legalizing cannabis will make it any easier for teenagers or young people to buy it, because it is so readily available already. By the end of Grade 12 in Ontario, 37 per cent of students will have used cannabis, according to a 2015 longitudinal CAMH study on drug use.

But psychologists and researchers want to have a more nuanced conversation about the drug’s potential harmful effects, especially as pot dispensaries open across Toronto, Vancouver and other Canadian cities. “A lot of teenagers who smoke dope say, ‘I smoke dope and so do all my friends and none of us have gone crazy,’ ” said Cory Gerritsen, a clinical psychologist who facilitates CAMH’s youth prevention clinic.

“They simply do not believe there are any risks.”

Thibodeau wants people to know that there are risks. He had never tried marijuana in high school. But when he started at the U of T in the fall of 2013, his roommate offered him a joint. He became hooked. He bought a vaporizer pipe and started smoking daily, and neglected his course work. Then the voices began.

“I had the sensation of a gust of wind in my ear and it was like a second consciousness talking to me,” he recalled. “At first, it was a force for good. But then the voice became abusive.”

The voice said he would die. And Thibodeau believed it to be true. He continued to smoke pot daily, and didn’t make the link between marijuana and his delusions until he ended up in CAMH a year later.

He was prescribed an anti-psychotic drug and enrolled in the youth prevention clinic. To combat his anxiety, he learned mindfulness meditation, as well as positive imaging and distraction techniques. Slowly, the voices retreated.

“We are trying to build up young people’s resilience and get them back on a positive trajectory,” said Gerritsen. “We are trying to prevent kids from becoming lost. If they say they cannot quit smoking dope, we send them to an addictions program.”

Research studies have found that people who use high doses of marijuana frequently over many years, or who start using it in adolescence, are at increased risk of suffering side effects. A review of research on the recreational use of the drug looked at 116 studies and concluded that it is linked to various mental effects, including panic attacks, anxiety, cognitive impairment and psychosis. The study was published in 2015 in Deutsches Arzteblatt, a German medical magazine.

Mizrahi, who is also a research scientist, is studying the effects of tetrahydrocannabinol (THC) and cannabidiol (CBD) — two ingredients in marijuana — on the brain, among smokers and non-smokers, patients with schizophrenia, and those at risk of developing it.

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THC provides a euphoric effect, while CBD has antipsychotic, anti-anxiety effects. In the past decade, growers have created strains with more THC because users enjoy the feeling of euphoria. But THC is also associated with psychosis.

“There are significant changes in the brain when people use cannabis,” she said. It may be that people self-medicate with marijuana because there is something wrong with their own natural endocannabinoid system, which regulates stress, she said.

Contrary to popular belief, cannabis can be addictive, though withdrawal symptoms are not as strong as they are for other drugs, such as heroin. Thibodeau said he fights the urge to smoke every day and feels a deep sense of shame about what happened to him, even as he looks forward to completing his degree and leaving the stoner life behind.

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